Free Essay

Stark Law

In: Social Issues

Submitted By brianjolly24
Words 693
Pages 3
STARK LAW
HCA322 HEALTH CARE ETHICS AND MEDICAL LAW
10/26/15

What is Stark Law?
According to starklaw.org, “Stark law, actually three separate provisions, governs physician self- referral for Medicare and Medicaid patients. The law is named for United States Congressman Pete Stark who sponsored the initial bill.” Dr. S and Dr. V were accused of violating the law after they sub leased a nuclear imaging camera from the local hospital so that they would not have to refer patients, and could perform the examinations on site. Qui tam action was brought by four other physicians who believe that the sublease violated the Stark Acts. This essay will further explore Stark Law, and decide whether or not Dr. S and Dr. V are guilty of committing a crime.

Dr. S and Dr. V Found Guilty?
“Faced with increasing evidence that health care practitioners were referring patients to other businesses owned or co-owned by the referring physician or a close family member, Representative Fortney Stark introduced a bill that would make these "self-referrals" illegal,” (Bustillos, D). To prevent physicians from creating a system in which they exploit patients for their own personal financial gain, Stark Law was put into effect. This law is very important because even though the medical community is a business, the quality care of patients should always be the top priority. Anytime large quantities of money can be accumulated it creates a corrupt system in which the financial aspect of the business is the main focus rather than the quality care of patients. In Dr. S and Dr. V’s circumstance however, it is not necessarily clear whether or not a crime was committed. They were only leasing the nuclear camera and did not have ownership or stake in the hospital, but that lease can be seen as a method of self referral since they were indeed technically business partners with the hospital they were leasing equipment from. Without further exploration into the case, one could conclude that the two physicians are guilty of the crime due to their business relationship with the hospital they shared patients with however, Stark Law is a lot more specific than just that scenario.

Were Dr.S and Dr. V Found Innocent?
The huge deciding factor that would make these two physicians obviously guilty to me is an arrangement in which the physicians would be obligated to refer patients to the hospital, which is non-existent in the information presented. It is fair to assume that the physicians had the freedom to refer their patients to whomever. Also, one of the main points of Stark Law is that physicians make arrangements with government entities, such as Medicare and Medicaid. From the information presented it is not clear whether or not the physicians Dr. S and Dr. V made prior arrangements with these government entities. Due to these circumstances, I feel as though the biggest thing that needs to be taken into consideration is the motive behind Dr. S and Dr. V’s business decision. If they were simply trying to make the process a lot simpler for their patients to undergo nuclear camera examination procedures, I do not think that is a crime. However, if their motive was to make more money this definitely raises concern. The only way to determine that would be to open the accounting books to understand the profit gains or loss from the two physician’s business partnership with the local hospital.

Conclusion
In conclusion, due to the lack of necessary evidence to determine the two physicians guilty, Dr. S and Dr. V are indeed innocent of any crime to my understanding. Their business decision was likely based on patient benefits rather than their own financial gains. The hospital also allowed their physicians to utilize the nuclear camera as well, which proves the two physicians did not have ownership over the camera or a structured compensation arrangement.

Resources

1. Bustillos, D. (2013). Health care ethics and medical law. San Diego, CA: Bridgepoint Education, (n.d.). Retrieved October 26, 2015.

2. STARK LAW - Information on penalties, legal practices, latest news and advice. (n.d.). Retrieved October 26, 2015.

Similar Documents

Premium Essay

Stark Law

...Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s purpose is to prohibit a physician from referring a patient for designated health services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare Beneficiaries, but Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The......

Words: 4961 - Pages: 20

Premium Essay

Stark Law and Radiology

...Stark Law and Radiologic Imaging Stark Law: some people consider it a highly needed federal law to help protect patients and insurance companies; others dread even the name and feel that it is just another way the federal government interferes with individuals’ daily lives, and see it as an unwanted intrusion into the practice of medicine. What is Stark Law and why was it enacted? Stark Law is actually three separate provisions that govern physicians’ self-referrals, mostly for payment by Medicare patients; it is also known as “the self-referral law.” “The law is named for United States Congressman Pete Stark, who sponsored the initial bill (“STARK LAW,” n.d., para. 1). The first phase became effective on January 1, 1992 (Taromina, 2013, p. 83). It prohibited a physician from referring a patient to a clinical laboratory with which they, or an immediate family member, had a financial relationship. The second phase became effective on January 4, 2001 (Taromina, 2013, p. 83). Stark II applied the already-enacted laws to Medicare and Medicaid patients, and extended the restrictions to include additional designated health services (DHS): physical therapy, occupational therapy, speech therapy, radiology services, radiation therapy, durable medical equipment and supplies, parenteral and enteral nutrients, equipment, and supplies, prosthetics, orthotics, and prosthetic devices and supplies, home health services, outpatient prescription drugs, inpatient and outpatient hospital......

Words: 1753 - Pages: 8

Premium Essay

Dealing with Fraud

...Dealing with Fraud By: Kevin McCarthy To: Dr. Michelle Rose HSA 515 Health Care Policy, Law, and Ethics December 13, 2012 Abstract As the Chief Nursing Officer, I am responsible for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. I will devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations Qui tam is shorthand for a Latin phrase that means “he who sues for the king as well as for himself.” In a qui tam case, the whistle – blower (aka relator) files the suit as a kind of “private attorney general” on behalf of the government. The government can choose to take over the prosecution, but if it declines to do so the relator can proceed alone (Showalter). Any person with information about health care fraud can be a qui tam plaintiff. Person is defined as “any natural person, partnership, corporation,......

Words: 3218 - Pages: 13

Premium Essay

Healthcare Fraud

...subject to regulatory boundaries, guidelines, and laws that cover their everyday business practices; one such over site agency is the Office of Inspector General (Dowell, 2002).This agency is responsible for regulating a number of government and private organizations including the permissible and impermissible hospital-physician joint ventures. When at least two parties establish an agreement to share control, benefits and the risks involved in an enterprise, there arrangement is considered a joint venture. This venture in itself is perfectly fine, however there are certain fraud alerts that the OIG must respond to. Once a physician refers a patient to a hospital or outpatient facility and that the referring physician has financial ties such that they will benefit financially from the use of that hospital or outpatient facility, the OIG will investigate for (1) the manner in which investors are selected: (2) the nature of the business; and (3) the finances and profit distributions and whether this arrangement violates federal Anti-Kickback statutes. The OIG issues advisory opinions that are of value to health care organizations and their legal staffs. The Department of Health and Human Services (HHS) provides safe harbor regulations for investment interest, investment of underserved areas, and ambulatory surgery centers that can protect investors from prosecution when the conditions of safe harbor arrangements are met. The Stark II law prevents physicians from making......

Words: 2420 - Pages: 10

Free Essay

Medicare Fraud

...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies INTRODUCTION In 1965, President Lyndon B. Johnson signed the Medicare Act into law. The purpose was to provide healthcare to individuals the age of 65 or older or individuals under the age of 65 diagnosed with specific medical conditions (Center for Medicare and Medicaid Services, 2013). The original intent was to provide immediate payment to those providing medical services for the less fortunate. The Medicare Act has since been revised to meet the current needs of the American population as well as the United States economy. In part, these revisions included identifying, combating, establishing punishment (criminal laws) and prevention for Medicare Fraud. This paper will provide a brief overview of the Medicare fraud history, incidence, costs and institutional remedies. MEDICARE FRAUD: HISTORY AND DEFINITION Fraudulent activities against the government were first addressed during the Civil War. The False Claims Act (qui tam statute), also known as the Lincoln Act, was passed during this time frame. The intent was to prevent the Union Army from being a victim of supplier fraud. Citizens were given, “the ability to file suits on behalf of the US government whenever they spotted fraud” (Medicare Fraud Center, 2015). The citizens were rewarded with a portion of the monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting......

Words: 3148 - Pages: 13

Free Essay

Test1

...you get this information? Health reform law has increased the number of patients therefore should be used as a major source of funding. Medicaid DSH funding has also been cited a major source of funding. (SEC, 2015) If I were unable to find this information I would research the 10 k report 4) Who is responsible for: a) the issuance, and Bass, Berry & Sims PLC b) the content of the company financial statements? Bass, Berry & Sims PLC (New York Stock Exchange, 2015) 5) What assurance, if any, is there that the financial statements are in compliance with GAAP, and are free of material misstatements? There are several instance in the 10k that show that they cannot give assurance some are listed below: * We attempt to structure our relationships to meet an exception to the Stark Law, but the regulations implementing the exceptions are detailed and complex, and we cannot provide assurance that every relationship complies fully with the Stark Law. Unlike the Anti-kickback Statute, failure to meet an exception under the Stark Law results in a violation of the Stark Law, even if such violation is technical in nature. (page 44 10k ) (HCA Holdings, 2015) * Although we believe our arrangements with physicians and other referral sources and referral recipients have been structured to comply with current law and available interpretations, there can be no assurance regulatory authorities enforcing these laws will determine these financial......

Words: 595 - Pages: 3

Free Essay

I Want to Blow Your Wooky

...Dealing with Fraud Liquid Professor Beharry Health Care Policy, Law, and Ethics March 18, 2013 Abstract This paper will evaluate how the Healthcare Qui Tam affects health care organizations while providing (4) examples of Qui Tam cases that exist in a variety of health care organizations. Other responsibilities discussed, are devising a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals; the ability to recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. The know how to devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations. The Healthcare Qui Tam affects health care organizations in that well over more than 450 hospitals across the country were the subject of Medicare fraud investigations. Whether or not Medicare violations are found, the costs of responding to an investigation can be significant. Westchester Medical Center of New York, being investigated for possible health care fraud and violations of anti-kickback laws, received a subpoena for extensive records in some thirty-seven categories going back to 1997. Millions of dollars may be spent in legal fees and other costs associated with the investigation (e.g., hiring or reassigning staff to assist with......

Words: 2629 - Pages: 11

Premium Essay

Hr Plan

...processes and one of the most challenging decision-making processes in an organization (Youssef-Morgan & Stark, 2014). The ultimate goal is to generate as large a pool as possible of applicants having the requisite knowledge, skills, abilities, and other characteristics associated with the focal job (Youssef-Morgan & Stark, 2014). Recruitment is an activity of establishing contact between employers and applicants. Employees are the backbone and most important resources a business can have, therefore, it is imperative that the organization has a highly functioning recruitment and selection process. Torrington et al., (2011 p. 157) states the first steps in recruitment should be pragmatic and straight forward. The best way to accomplish this is to conduct a job analysis. Ideally job skills analysis should be incorporated with a strategic assessment of HR requirements so that the organization can be confident that they have the necessary skills contained within the human capital of the business to achieve long-term organizational objectives (Rivera, 2012b, p.75). When starting the recruitment process HR must be sure to maintain nondiscriminatory practices while determining employee eligibility. Extreme caution must be used to ensure selection procedures are appropriately and purposefully designed to address only information that pertains to a job (Youssef-Morgan & Stark, 2014). External and internal applicants will be a part of the recruitment process. Job......

Words: 2779 - Pages: 12

Premium Essay

Financial Laws

...Financial Laws Theodore Gladney Health Services Finance Professor:  Alison Williams Financial Laws Five Elements Pertaining To the Establishment of a False Claim under the False Claims Act The five elements necessary to establish a false claim must determine that the claim was in breach of State laws. It must be proved beyond reasonable doubt that the claim was false, fraudulent or fictitious and made for a monetary benefit. The false claim is established when an individual is in possession of a property or money used by the government with the intention to defraud the government (Boese, 2005). It must also be established that the ‘false claim’ was made with actual knowledge. False certification of receipt of property without attempting to confirm the truth of the information provided is also an element that constitutes false claim. Three Broad Objectives of HIPAA Privacy Standards HIPAA privacy standards aims to achieve the following three important objectives: i) Administrative Safeguards HIPAA privacy rules designed procedures and policies regarding the administrative procedures of the act; how will the act be complied with. ii) Physical Safeguards HIPAA privacy rules were designed to control physical access to guard against inappropriate access to personal healthcare information. iii) Technical Safeguards HIPAA privacy rules control access to computer systems and facilitate enclosed entities to protect interactions involving PHI transmitted...

Words: 678 - Pages: 3

Premium Essay

Final Laws Ans Regulation

...Financial Laws & Regulations By Joanna Ramos Professor: Maribel Lebron DeVry University HSM 340 November 3, 2013 1. What are five elements pertaining to the establishment of a false claim under the False Claims Act? * Qui tam – also known as a “whistleblower” and that exposes misconduct, alleged dishonest or illegal activity occurring in an organization. It can be classified in many ways; for example, a violation of a law, rule, regulation and/or a direct threat to public interest , such as fraud health and safety violations, and corruption * Kick Backs - is a form of negotiated bribery in which a commission is paid to the bribe-taker Self * Self-Referrals – This to avoid the abuse of authorities and for misconstruing fraudulent information. * Anti-Kickback State(AKS)- “states that no person may offer or request, give, or receive remuneration in exchange for a referral for a good or service that may be reimbursed under a federal healthcare program (e.g., Medicare)” (Cleverly & Cameron, pg.92). * Stark Law – “The Stark Law prohibits a physician from referring a patient for certain “designated health services” to an entity with which the physician has a “financial relationship”” ( Cleverly & Cameron, Pg.93). 2.HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each. * Health care insurance portability act and accounting act of 1996- This act gives the right to privacy to individuals from......

Words: 649 - Pages: 3

Premium Essay

Starklaw

...With the introduction of the Stark Law, the medical field has been brought closer to its roots as a trusted and beneficial source of information and patient care. I think that with the introduction to the law, the benefit seen by the patient has been immense. The making of referrals based on financial gain, while also somewhat unethical, can usually never turn out to be in the patient’s best interest. With the physician holding all the power in making the referral, unless a more informed patient makes a specific request, the patient can end up anywhere regardless of the professions reputation, quality of care, location, costs and insurance acceptance. Having more information in all of the areas mentioned are important and critical to a patient. With the Stark law in place, physicians can now undoubtedly assist the patient in making a more informed unbiased decision on where to receive care. I think that for both the practice and the patient, the benefits of this have been quite significant. The practice can be sure that the patient is getting the best care possible, while still maintaining a high degree of ethics, and the patient can have all doubt removed from their mind that the care they are receiving is from a qualified individual based on another physicians best judgment, and not just financial gain. This law was a much needed change in the medical field to restore faith in the practices of doctors by patients. The medical industry is and always will be a......

Words: 302 - Pages: 2

Free Essay

Financial Laws & Regulations

...regards to PHI.1 Adopt Administrative Safeguards. Lastly, the third broad objective of HIPAA’s privacy standards is to require covered entities to adopt administrative safeguards to protect the confidentiality and privacy of PHI. Covered entities must adopt organization-wide policies and procedures which safeguard the privacy of patients and their health information. All stakeholders of the organization should be educated and trained regarding these policies and procedures to mitigate risk of the organization violating HIPAA privacy standards. Stark Law The Stark Law prohibit physician referrals to entities in which the physician has a financial interest, direct or indirect, including ownership, investment, and compensation relationships.1 Stark Law is intended to prevent physicians from making decisions for patients based on their financial gain and, instead, to always do what is in the best interest of the patient. The law designates ten specific health services (DHS) for which providers with financial interest with the potential referred entity are prohibited from referring patients to. These include 1) clinical laboratory services; 2) physical therapy, occupational therapy, and speech-language pathology services; 3) radiology and certain other imaging services; 4) radiation therapy services and supplies; 5) durable medical equipment and supplies; 6) parenteral and enteral nutrients, equipment, and supplies; 7) prosthetics, orthotics, and prosthetic devices; 8) home......

Words: 947 - Pages: 4

Free Essay

Religion in America

...special court appointed by the governor of Massachusetts that was disbanded once the ulterior motives of the accusers became obvious. Religious writings were also the most popular form of printed material until 1765, when political writings became available leading up to the Revolutionary War. Even through the conflict, religious writings still rivaled the political discourse. Two documents that are consistently identified with having religious influence are the Declaration of Independence and the Constitution. Written by Thomas Jefferson, the Declaration of Independence contains several references that are difficult to interpret any way but as religious. In the very first sentence, Jefferson discusses a people and the station “to which the laws of nature and nature’s God entitle them.” There is also a reference to men being endowed with unalienable rights by their creator. Although the Constitution does not contain any overtly religious language, those who were involved with the writing and interpretation of it were most certainly educated, religious men whose faith had a hand in the direction of our young republic. Those who made up the group in charge of drafting our founding document unanimously identified themselves as Christians. With the exception of two delegates that identified themselves with the Roman Catholic Church, the balance of the delegates were protestant and nearly 70 percent of them claimed membership in the Episcopal Church. Even during the meetings......

Words: 2718 - Pages: 11

Premium Essay

Physician Referall

...resources, if any, that are reasonably available, informed that they have the option to use one of the alternative resources, and assured that they will not be treated differently by the physician if they choose an alternative provider or entity. Physicians should make referrals to providers based only on the needs of the patient and the medical standard of care in order to provide quality health care to their patients. References: Stark 42-USC-1395nn 42 C.F.R. 411.350 et seq. Stark 42-USC-1320a-7b 42 C.F.R. 1001.951 American Medical Association Council on Long Range Planning and Development in cooperation with the Council on Constitution and Bylaws, and the Council on Ethical and Judicial Affairs. Policy Compendium. Chicago: American Medical Association, 1999, E-8.00, 106-111. Code of Medical Ethics, Current Opinions and Annotations, Council on Ethical and Judicial Affairs, American Medical Association: 95, 108-112. The Physician Ownership and Referral Act (PORA) Cal. Bus. & Prof. Code §650.01 Stark II Regulations: The Good, The Bad & The Ugly, Law Watch, Foley Lardner Weissburg & Aronson, Jan. 15, 1998. Disclosing Physician Financial Incentives, JAMA, 1999;281: 1424-1430. Adopted by the Board of Trustees, 9/24/99 Amendments adopted by the Board of Trustees, 2/21/04 POLICY 33 Disclosure of Financial Interest in Prescribed Medical Products and Services Physicians may be involved in medical decision-making processes that may have significant financial impact on......

Words: 482 - Pages: 2

Premium Essay

Hsa 515

...original source of information that was previously disclosed. The federal law provides a solution for whistle-blowers who are discharged, demoted, harassed, or discriminated against. This type of law suit has become popular and effective in fighting fraud and abuse because of this protection (Showalter, 2012). In healthcare, sometimes the qui tam plaintiffs argue that a claim involving a kickback or an illegal doctor self-referral is a violation of the False Claims Act (FCA). The case may be legitimate otherwise. One case is the United States ex rel. Marcus v. Hess. In this WWII case the contractor’s claims were fraudulent because the contract was secured through collusion. Another case, United States ex. rel. Woodard v. Country View Care Center, Inc. involved defendants who submitted cost reports to Medicare payments to “consultants” that was really kickbacks for referrals. The FCA applied to this case because the defendants’ reimbursement was based on these cost reports. In United States v. Kensington Hospital, the case was filed after arguments resulted from the start of the prospective payment system relating to Medicaid reimbursement, government losses, and the cost of kickbacks not making false claims. United States ex rel. Pogue v. American Healthcorp, the FCA case was not dismissed due to the violations of the anti-kickback and Stark self-referral laws (Showalter, 2012). The Stark Self-Referral Law states that physicians are prohibited from referring either......

Words: 770 - Pages: 4